| NPI | 1912770520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCUS STANTON COSPER Owner 330-507-2988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |